Every day, acute and critical care nurses are faced with emotionally devastating situations in which patients are subjected to invasive, life-sustaining treatments with little hope for meaningful recovery, simply because no advance directive or health care power of attorney has been executed.

The 1990 Patient Self Determination Act regulated that all patients entering health care institutions that receive Medicare or Medicaid funds be provided with written information about their right under state law to execute advance directives if they have not previously done so. This regulation has resulted in admission processes that include inquiring if a patient has an advance directive and if not; organizations are required to provide information only. The regulation does not provide any clarity about the patients’ understanding of advance directives.

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